The clinical picture of a child suffering from chronic indigestion is a varied one. The child may be well nourished, but more commonly it shows wasting, often in marked degree. Listlessness and a general physical and mental apathy are prominent features, and these are associated with loss of appetite, distaste for ordinary food, and often a distinct degree of anemia. A derangement of the bowels is usually present, the bowels being constipated or loose, the motions being offensive and containing undigested foodstuffs. In rare cases the anemia may become very pronounced, the condition becoming one of severe anemia, the treatment of which is discussed in the section on Diseases of the Blood.

The condition arises from over-feeding or injudicious feeding of long duration. Too much tea, excess of sweets, and the too liberal indulgence in carbohydrate foods, especially bread and starchy puddings, are commonly noted causes; in the children of gouty parents the main defect is usually a general excess of all the foodstuffs, more especially farinaceous or meat foods (see also Food Fever, p. 350). Some cases are associated with hyperchlorhydria, and in these cases treatment must be conducted along the lines laid down for that condition. Whatever the cause may be the indications for treatment can be clearly defined.

Treatment

The whole digestive tract must get a rest, by the administration of only small quantities of the most easily digested foodstuffs given in fluid form. The benefits of this treatment are often more quickly obtained by keeping the patient in bed for a few days, and clearing out the bowel thoroughly as a preliminary measure.

The diet at the outset should consist of peptonised whey, weak beef-tea, or weak mutton, veal, and chicken soup, given in 3 to 4 ounce feeds, with net more than a finger of crisp toast. In some cases breadstuffs are better withheld till later. In twenty-four or thirty-six hours, skimmed milk, plain or peptonised, may be added to the diet, which may also include chicken jelly, meat juice, and the like. Ordinary milk, plain or peptonised, may soon be given, but the effect of it must be carefully observed both on the patient's symptoms and on the condition of the stools. If it is well tolerated it may then be fortified by the addition of white of egg, Plasmon, Protene, and Sanatogen, and by the addition of simply prepared fish, chicken, or sweetbread. Carbohydrates must be added very cautiously, beginning with a little crisp toast, rusk, or stale bread, going on to a plain milk pudding or prepared invalid food - Savory & Moore's, Benger's, or Allen-bury food (p. 183). There is frequently some difficulty in the digestion of carbohydrates, and this may be overcome by the administration of Extract of malt or Maltine. As the state of digestion improves, fat is cautiously added in the forrii of butter, cream, and yolk of eggs.

To Prevent A Recurrence

Special care must be taken with the subsequent feeding of the child. The amount of farinaceous foods and sweets must be carefully regulated, and excess in either avoided. Particular attention must be directed to the thorough mastication of the food. This is of value in two directions. It imitates the normal digestive process in the mouth, and so favours a healthy gastric and intestinal digestion; and it diminishes the risk of eating to excess. Food must, therefore, be selected which promotes mastication. Beef and mutton should be given in the form of roast or boiled, and not mince meat; and the child should be encouraged to take crusts, crisp toast, hard biscuits, and other Is which require chewing.

A diet suitable for a child of seven is here given. It must be observed that the number of meals is restricted, no food is given between meals, and the carbohydrates and fats are especially reduced.

Diet

8 a.m.: Breakfast-Cup of milk and hot water (unsweetened), allowing 10 ounces of milk. Bit offish; or ham or tongue.

Slice of toast, and a couple of rusks or Vienna roll and a very little butter.

I:.30: Dinner - Milk, 6 to 8 ounces diluted.

A good helping.

Fish, with white sauce and potato; or Chicken, with bread sauce or cauliflower; or Roast mutton, gravy, and a vegetable (cabbage puree).

I'udding, milk pudding, with stewed fruit; or custard, with raw apple; or jelly, or a meringue; only a little sugar and cream. Dry toast or rusks, given as much as the child requires. 4 P.M. - Milk, 10 ounces; bread and butter, limited to 1 slice; rusks and dry biscuit, as much as child will take. Sweet cakes to be taken very sparingly. 6.30 P.M. - Cup of soup, thickened with well-boiled sago, macaroni, vermicelli, or barley. Slice of toast.